A major change to how Maryland pays for substance-abuse treatment has brought an increase in the number of addicts and alcoholics who get help—but allows many other needy people to slip through the cracks. Susan Tangires, LCPC, LCADC, the director of Epoch Counseling Center, which runs a network of non-profit drug and alcohol treatment centers in the state, tells The Fix that previously, “Substance-abuse treatment for uninsured individuals was covered through block grant funding—federal money that flows to and is distributed by each state.” But in 2009, the Maryland legislature decided to begin making annual transfers of funds from the state’s Alcohol and Drug Abuse Administration (ADAA) grant program to its Medicaid program, in order to qualify for federal matching funds and increase the sums available to pay for substance-abuse treatment for poorer people.

While that plan makes sense to Tangires—and, according to Maryland’s Dept. of Health and Mental Hygiene, has contributed to a jump from 1,946 participants in Medicaid’s Primary Adult Care (PAC) program in Maryland in 2009 to a projected 16,351 this year—it also has some problems. Tangires tells us that while the previous system of block-grant funding was “secure and counted-on,” dollar amounts using the Medicaid system are tied to how many people a treatment center serves, and how many services it provides. Not only that, but to get reimbursed, treatment centers must bill one of seven different managed-care organizations, adding complexity to the process.

“In the past, programs had the ability to take people in whether they had insurance coverage or not," Tangires says, "and now it’s going to be really important for people to apply for Medicaid.” That's simple in theory. But many who are eligible for the program don't follow through in the application process. More ominously, Tangires also points out that Medicare, the federal insurance program for the elderly, doesn't cover substance-abuse treatment. “We are definitely seeing an aging of our substance-abuse population,” she says. “They’ve been served by block-grant funding in the past, but not any longer.”

Epoch knew for several years that this change was coming, but had no idea how big a cash loss it would represent. Although Tangires initially expected a cut of 8–10%, she was told in May that Epoch’s funding would be slashed by nearly $300,000—20% of its grant money, or 10% of its overall operating budget. “There was no way we were going to be able to absorb that amount of cut quickly, so the only thing we really could do was to close the smallest of our four centers,” says Tangires. This is Epoch’s Lansdowne center, which has been treating 90 people at a time on an outpatient basis (Epoch doesn't provide residential treatment). Tangires explains that they're currently trying to whittle down the number of people at Lansdowne to 40 or 50 who will—in a month or two, when Lansdowne closes for good—be willing to transition to Epoch’s Catonsville center, which has a capacity of 175. So Epoch has stopped taking clients at Lansdowne, and has instead been adding names to a lengthening wait list. “But what we’ve found from having a wait list … is that when we finally lift it, maybe one out of 20 people actually show up,” Tangires says. “It wasn’t that they went somewhere else, it was just that they didn’t come back.”

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Charlie Sheen doesn't listen to many people, especially when it comes to his hard-partying. But there's one person whose advice apparently did resonate: Clint Eastwood. Sheen revealed on the TV sports show Centerstage that the Oscar-winning actor took part in an intervention with family and friends during the peak of Sheen's troubles, ultimately convincing him to go into rehab. "There's a phone call at the very end [of the intervention], and it's Clint Eastwood," said Sheen. "And he says, 'Come on, kid, you know, you're tougher than this, just go fix yourself, get back in the game.' And I was like, 'Alright, Clint.' How do you say no to Dirty Harry, you know? So I went [into rehab]... It helped at the time." Sheen and Eastwood had become friends after working together on the 1990 film The Rookie. But it doesn't seem like rehab taught Sheen much. He recently said he doesn't believe in it. And the contents of his tiger blood are open to speculation after he refused to take drug tests with FX during production of his current show Anger Management—and gave a mysterious, poetic response when confronted by drug allegations earlier this year.

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Ohio passed a law in March that allows addicts' families to force their loved ones to go to rehab. But it's been used just once since being put on the books. That case involved a woman with severe alcoholism from the Cleveland area—she's reportedly responded well by agreeing to stay in treatment beyond the court-mandated time frame. It appears that money is the biggest reason more families aren't utilizing the law. Cuyahoga County Probate Court Magistrate David Mills says that his court has received numerous inquiries about it. But families generally choose not to move forward after learning they must sign an up-front agreement to pay the total bill for treatment and give the court a deposit for half of the amount—typically several thousand dollars. "While we have problems with this, we don't chastise the intent to try and help someone who needs help," says Bill Denihan, CEO of Cuyahoga County's Board of Alcohol, Drug Addiction and Mental Health Services. "But this is for those that have money. The question we have is what about those who don't have money? How is this fair and equitable?" Addicts who don't want treatment could also potentially challenge forced rehab as a violation of their civil rights. Elsewhere, Kentucky introduced a similar law eight years ago that doesn't require signed agreements or up-front deposits, while up to 38 states have some type of law that allowing addicts to be temporarily detained—but usually just for a few days—if they're deemed a danger to themselves. 

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With London 2012 close on the horizon, an anonymous female athlete has apparently been spilling all the dirty secrets from Olympic Villages past. “What happens in the Village stays in the Village,” the US Olympian tells the New York Post. And what happens for many competitors at the world's most prestigious sports event is said to consist of sex, drugs and booze. Though alcohol and drugs are banned from Olympic villages, the athletes still find a way to sneak it in. “When I’m there, I’m in two different gears,” says. “I’m so focused that I see nothing else, or I’m partying my butt off.” The villages are said to divide into two groups: the elite, who train and abstain from partying, and the others. Who don’t. “At the Olympic Village, they call it ‘Days of Glory,’” says the source. “You stay up all night and party, and you wait for McDonald’s to start serving breakfast at 4:30 in the morning. You eat, sleep, then get up at 9 or 10 am for press, and then you start partying all over again. The “lesser” athletes, of whom fewer physical demands are made, have the biggest boozing reputation: “Curlers are known for drinking. The sport doesn’t require that much.” Another unusual US Olympic tradition is getting so wasted the night before the post-games trip to the White House that you're still drunk as you shake hands with the president. “It’s a sobering experience, knowing you were still drunk at 5 am and are on a bus by 7 to meet the president at 10,” says US Nordic Combined Athlete Todd Lodwick. “When the Games are over, I’m in peak drunk state.”

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• Revolutionary New Drug Vivitrol Offers New Life to Addicts [Detroit Free Press]
• Toxicology Results Show No Alcohol Found in Mary Kennedy's System [CNN]
• New Ohio Law Allows Families to Force Addicts Into Treatment [Cleveland.com]
• "Prescription Tourists" Thwart States' Crackdown on Illegal Painkiller Sales [MSNBC]
• Arizona Police Dismantle Cell of Sinaloa Cartel [CNN]
• Dr. Gabriel G. Nahas, Marijuana Opponent, Dies at 92 [New York Times]
• A.J. Allmendinger Suspended for Failing Random Drug Test [CBS Sports]

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Cary, a 51-year-old Elvis impersonator from Brooklyn, has led a double life for years: living every moment in front of the crowd, then returning home to an apartment crammed with Elvis memorablia, stacks of yellowed newspapers, and insects crawling across piles of rotting food. This Sunday, in the harrowing Season Four opener of TLC's Hoarding: Buried Alive, attempts to clear his accumulated mess lead to rage, tears and sheer panic. The episode was filmed in March. When The Fix speaks with Cary, months after this "very distressing" experience, he's in Myrtle Beach, SC, where he's just appeared in an Elvis impersonators' contest.

"It went well," he says. "I came ninth out of 21 Elvises. The crowd gave me a very good reception." Cary shared his devotion to The King with his mother, whom he lost to cancer in 1992; it was after he took over her apartment that his compulsive hoarding began. Diagnosed with manic depression and an anxiety disorder, he survived on disability money and his slim Elvis earnings, while filling his home to the point where he could hardly move around it. He talks during the show about his fear that he'll "run out of stuff," which causes him to gather more. "I'm a poor man!" he yells. "I need more stuff in the house that makes me feel rich!" 

This attachment made his appearance on Hoarding a hard decision. "I needed a lot of persuading," he tells us. "I really didn't want to do it." Although he admits the publicity "might give [my career] a little boost," and that he's had "some great reactions" after TLC aired its trailers, he insists, "That's not the reason I did Hoarding; I did it because I needed help." Watching the episode makes it easy to believe him. But despite the ongoing support he's received since March—therapy, plus mood stabilizers and SSRIs, prescribed by a new psychiatrist—there's no silver bullet. Cary sounds calm but subdued when he says, "Things have improved, they're a little bit better than they were. But I'm not cured yet." He misses his discarded possessions less than he did, and his apartment remains "way much better than it was." 

Dr. Beccy Beaton, the psychologist who worked with Cary during filming, has stayed in touch: "I wanted to be sure we didn't hurt him," she tells The Fix. She says that Cary's additional mental health problems made his hoarding particularly hard to address. "He was distraught over the idea of losing his things," she recalls. "We were worried it would have a detrimental effect on his overall mental health." When her efforts hit a wall, she decided to apply a harm reduction strategy—something more commonly associated with substance addictions. This involved introducing compromises, like clearing pathways through Cary's possessions to the fire escape or the window, so he wouldn't have to give up everything. Beaton, who has worked with many hoarders, notes that compulsive hoarding is classified as an anxiety disorder, rather than an addiction. But she believes there's "a very addictive component to it." Which means, she says, that many strategies used to help addicts, such as interventions or 12-step groups (like Clutterers Anonymous), can help hoarders, too. 

Beaton is outspoken in her criticism of some of Cary's friends, who are seen berating him during the episode [below]. "I feel like those friends are abusive to him," she tells us. "But people who are abused often prefer to have those relationships, rather than nobody." For now, Cary chooses to keep these friends—they're currently with him in Myrtle Beach. "He has another friend in his life who's actually very nice," says Beaton. "Hopefully other people in his life will help keep him on track." But she isn't over-optimistic in her assessment of Cary's long-term outlook: "Where it is now is probably how it will stay." Compulsive hoarding is a condition that professionals usually have to seek to manage, she says, rather than cure. Cary, meanwhile, plans to continue impersonating Elvis: his favorite songs to perform are "Viva Las Vegas," "Can't Help Falling in Love" and "Suspicious Minds." 

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